Clin Colon Rectal Surg 2010; 23(1): 014-020
DOI: 10.1055/s-0030-1247852
© Thieme Medical Publishers

Sedation, Analgesia, and Monitoring

Travis F. Wiggins1 , Abdul S. Khan1 , Nathaniel S. Winstead1 , 2
  • 1Department of Gastroenterology, Ochsner Clinic Foundation, New Orleans, Louisiana
  • 2Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
Further Information

Publication History

Publication Date:
09 March 2010 (online)

ABSTRACT

Endoscopic procedures are common and sedation is frequently used to minimize anxiety and discomfort, reduce the potential for physical injury during the procedure, and improve overall patient tolerability and satisfaction. In this article, the authors review the variety of options for sedation and analgesia available to the gastroenterologist or surgical endoscopist.

REFERENCES

  • 1 Wolff W I, Shinya H. Colonofiberoscopy.  JAMA. 1971;  217(11) 1509-1512
  • 2 Cappell M S, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complications.  Med Clin North Am. 2002;  86(6) 1253-1288
  • 3 Cohen L B, Delegge M H, Aisenberg J AGA Institute et al. AGA Institute review of endoscopic sedation.  Gastroenterology. 2007;  133(2) 675-701
  • 4 Cohen L B, Wecsler J S, Gaetano J N et al.. Endoscopic sedation in the United States: results from a nationwide survey.  Am J Gastroenterol. 2006;  101(5) 967-974
  • 5 Gross J B, Bailey P L, Connis R T American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists et al. Practice guidelines for sedation and analgesia by non-anesthesiologists.  Anesthesiology. 2002;  96(4) 1004-1017
  • 6 Warner M A, Caplan R A, Epstein B S et al.. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting.  Anesthesiology. 1999;  90(3) 896-905
  • 7 Lichtenstein D R, Jagannath S, Baron T H Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy et al. Sedation and anesthesia in GI endoscopy.  Gastrointest Endosc. 2008;  68(5) 815-826
  • 8 Qureshi W A, Rajan E, Adler D G American Society for Gastrointestinal Endoscopy et al. ASGE Guideline: Guidelines for endoscopy in pregnant and lactating women.  Gastrointest Endosc. 2005;  61(3) 357-362
  • 9 Reves J G, Fragen R J, Vinik H R, Greenblatt D J. Midazolam: pharmacology and uses.  Anesthesiology. 1985;  62(3) 310-324
  • 10 Horn E, Nesbit S A. Pharmacology and pharmacokinetics of sedatives and analgesics.  Gastrointest Endosc Clin N Am. 2004;  14(2) 247-268
  • 11 Zakko S F, Seifert H A, Gross J B. A comparison of midazolam and diazepam for conscious sedation during colonoscopy in a prospective double-blind study.  Gastrointest Endosc. 1999;  49(6) 684-689
  • 12 Cole S G, Brozinsky S, Isenberg J I. Midazolam, a new more potent benzodiazepine, compared with diazepam: a randomized, double-blind study of preendoscopic sedatives.  Gastrointest Endosc. 1983;  29(3) 219-222
  • 13 Lee M G, Hanna W, Harding H. Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam.  Gastrointest Endosc. 1989;  35(2) 82-84
  • 14 McQuaid K R, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures.  Gastrointest Endosc. 2008;  67(6) 910-923
  • 15 Bahn E L, Holt K R. Procedural sedation and analgesia: a review and new concepts.  Emerg Med Clin North Am. 2005;  23(2) 503-517
  • 16 Waring J P, Baron T H, Hirota W K American Society for Gastrointestinal Endoscopy, Standards of Practice Committee et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy.  Gastrointest Endosc. 2003;  58(3) 317-322
  • 17 Mora C T, Torjman M, White P F. Sedative and ventilatory effects of midazolam infusion: effect of flumazenil reversal.  Can J Anaesth. 1995;  42(8) 677-684
  • 18 Robertson D J, Jacobs D P, Mackenzie T A, Oringer J A, Rothstein R I. Clinical trial: a randomized, study comparing meperidine (pethidine) and fentanyl in adult gastrointestinal endoscopy.  Aliment Pharmacol Ther. 2009;  29(8) 817-823
  • 19 Scholz J, Steinfath M, Schulz M. Clinical pharmacokinetics of alfentanil, fentanyl and sufentanil. An update.  Clin Pharmacokinet. 1996;  31(4) 275-292
  • 20 Umans J G, Inturrisi C E. Antinociceptive activity and toxicity of meperidine and normeperidine in mice.  J Pharmacol Exp Ther. 1982;  223(1) 203-206
  • 21 Bodenham A, Shelly M P, Park G R. The altered pharmacokinetics and pharmacodynamics of drugs commonly used in critically ill patients.  Clin Pharmacokinet. 1988;  14(6) 347-373
  • 22 Graber R G. Propofol in the endoscopy suite: an anesthesiologist's perspective.  , [editorial; comment] Gastrointest Endosc. 1999;  49(6) 803-806
  • 23 Cohen L B, Hightower C D, Wood D A, Miller K M, Aisenberg J. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam.  Gastrointest Endosc. 2004;  59(7) 795-803
  • 24 Cohen L B, Hightower C D, Wood D A, Miller K M, Aisenberg J. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam.  Gastrointest Endosc. 2004;  59(7) 795-803
  • 25 Sipe B W, Scheidler M, Baluyut A et al.. A prospective safety study of a low-dose propofol sedation protocol for colonoscopy.  Clin Gastroenterol Hepatol. 2007;  5 563-566
  • 26 Bryson H M, Fulton B R, Faulds D. Propofol. An update of its use in anaesthesia and conscious sedation.  Drugs. 1995;  50(3) 513-559
  • 27 Byrne M F, Baillie J. Nurse-assisted propofol sedation: the jury is in!.  Gastroenterology. 2005;  129(5) 1781-1782
  • 28 Clarke A C, Chiragakis L, Hillman L C, Kaye G L. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists.  Med J Aust. 2002;  176(4) 158-161
  • 29 Rex D K, Deenadayalu V, Eid E. Gastroenterologist-directed propofol: an update.  Gastrointest Endosc Clin N Am. 2008;  18(4) 717-725, ix
  • 30 Rex D K, Heuss L T, Walker J A, Qi R. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy.  Gastroenterology. 2005;  129(5) 1384-1391
  • 31 Heuss L T, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients–a prospective, controlled study.  Am J Gastroenterol. 2003;  98(8) 1751-1757
  • 32 Dikman A E, Sanyal S, Aisenberg J et al.. Gastroenterologist-directed, balanced propofol sedation for EGD and colonoscopy: an analysis of safety in 15,286 patients.  Gastrointest Endosc. 2008;  67 AB84
  • 33 Singh H, Poluha W, Cheung M, Choptain N, Baron K I, Taback S P. Propofol for sedation during colonoscopy.  Cochrane Database Syst Rev. 2008;  (4) CD006268
  • 34 Joint Statement of a Working Group from the American College of Gastroenterology (ACG) .Recommendations on the administration of sedation for the performance of endoscopic procedures. Available at: http://www.gastro.org/wmspage.cfm?parm1_371 Accessed October 14, 2009
  • 35 Rex D K, Imperiale T F, Portish V. Patients willing to try colonoscopy without sedation: associated clinical factors and results of a randomized controlled trial.  Gastrointest Endosc. 1999;  49(5) 554-559
  • 36 Tsai M S, Su Y H, Liang J T, Lai H S, Lee P H. Patient factors predicting the completion of sedation-free colonoscopy.  Hepatogastroenterology. 2008;  55(86-87) 1606-1608
  • 37 Siebig S, Rockmann F, Sabel K et al.. Continuous non-invasive arterial pressure technique improves patient monitoring during interventional endoscopy.  Int J Med Sci. 2009;  6(1) 37-42
  • 38 Poirier M P, Gonzalez Del-Rey J A, McAneney C M, DiGiulio G A. Utility of monitoring capnography, pulse oximetry, and vital signs in the detection of airway mishaps: a hyperoxemic animal model.  Am J Emerg Med. 1998;  16(4) 350-352
  • 39 Vargo J J, Zuccaro Jr G, Dumot J A, Conwell D L, Morrow J B, Shay S S. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy.  Gastrointest Endosc. 2002;  55(7) 826-831
  • 40 Lightdale J R, Goldmann D A, Feldman H A, Newburg A R, DiNardo J A, Fox V L. Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial.  Pediatrics. 2006;  117(6) e1170-e1178
  • 41 Vargo J J, Zuccaro Jr G, Dumot J A, Conwell D L, Morrow J B, Shay S S. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy.  Gastrointest Endosc. 2002;  55(7) 826-831
  • 42 Drover D R, Lemmens H J, Pierce E T et al.. Patient state index: titration of delivery and recovery from propofol, alfentanil, and nitrous oxide anesthesia.  Anesthesiology. 2002;  97(1) 82-89
  • 43 Rosow C, Manberg P J. Bispectral index monitoring.  Anesthesiol Clin North America. 2001;  19(4) 947-966, xi
  • 44 Overly F L, Wright R O, Connor Jr F A, Fontaine B, Jay G, Linakis J G. Bispectral analysis during pediatric procedural sedation.  Pediatr Emerg Care. 2005;  21(1) 6-11
  • 45 Agrawal D, Feldman H A, Krauss B, Waltzman M L. Bispectral index monitoring quantifies depth of sedation during emergency department procedural sedation and analgesia in children.  Ann Emerg Med. 2004;  43(2) 247-255
  • 46 Absalom A R, Menon D K. BIS and spectral entropy monitoring during sedation with midazolam/remifentanil and dexmedetomidine/remifentanil.  Crit Care. 2009;  13(2) 137
  • 47 Bailey P L, Zuccaro Jr G. Sedation for endoscopic procedures: not as simple as it seems.  Am J Gastroenterol. 2006;  101(9) 2008-2010
  • 48 Pambianco D J, Whitten C J, Moerman A, Struys M M, Martin J F. An assessment of computer-assisted personalized sedation: a sedation delivery system to administer propofol for gastrointestinal endoscopy.  Gastrointest Endosc. 2008;  68(3) 542-547

Nathaniel S WinsteadM.D. 

Department of Gastroenterology, Ochsner Clinic Foundation

1514 Jefferson Hwy., New Orleans, LA 70121

Email: Nwinstead@ochsner.org

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